kyouens

I don't see much chance of a slowdown without government regulation; the economics make it practically impossible. And I don't seem much chance of government regulation unless there is global consensus. With the entire global order under threat, that doesn't seem likely, either. I expect we are stuck with reading dire blog posts and worrying for the time being.

Please let the zillions of people still fogging into my hometown (an Austin suburb) know!

Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.

I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.

In this conversation, it’s important to distinguish science itself (which, along with facts, are already under attack in our politics) from failings of the research industry.

You are right, to an extent. Health systems and EHR vendors both have historically had an economic disincentive to share data. Think “ecosystem lock-in”. My impression is that things are gradually changing for the better.

Couple of points: The 21st Century Cures Act has recently expanded rules for information portability, which will make it much easier to get access to your data in the future. The challenge here has nothing to do with radiologists hoarding your data. The lack of interoperability typically stems from limitations of electronic health information systems. Most radiologists would love to be able to look at your scans from multiple previous hospitals where you were imaged previously, but technical barriers currently make that difficult.

I'm also a physician. I am generally satisfied with my work, but I do feel distressed by what feels to me like erosion of the social contract between doctors and society that flourished during the second half of the twentieth century. It sounds like we agree that some of that erosion has occurred because of nakedly self-serving political action by medical professional societies.

When I made the decision to become a physician twenty years ago, I thought medicine was my calling. I believed that the personal sacrifices one makes to be a physician--and there are many--would be rewarded with professional pride, the respect of my community, the gratitude of my patients, and a secure and well-paid living. I have gotten a little wiser, I think. I make a good living, my work is interesting, and I still think medicine is a great career. But times have changed, and I no longer consider medicine a calling for which one should be willing to sacrifice one's personal well-being. I find myself defending my profession on the internet a little more than I'd anticipated :)

Those who control the business of medicine take economic advantage of the patient-first mindset of our medical tradition, and it cheapens what we do, both literally and figuratively. It is for that reason that, despite its many flaws, I do think organized medicine does have redeeming qualities. It gives physicians at least some voice in politics, where they would otherwise have none at all. Maybe one day health care reform will right the ship.

The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem.

I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist.

One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.

The issue of positive predictive value versus specificity comes up almost every day in my work as a pathologist. There is widespread misunderstanding, and in my own anecdotal experience, it very frequently results in unnecessary lab testing and misinterpretation of test results by clinicians.

When I was a pre-med student, for some reason the prerequisites required a year of calculus. That succeeded in weeding out people who can't make an A in freshman calculus, but I'm not sure what else it accomplished. Calculus has little to do with the daily practice of medicine, unless you're a radiation oncologist or doing some hardcore research.

A year of statistics would have served me and my patients much better. That goes double, given the current firehose of data that is part and parcel of the personalized medicine revolution.

I am doing the same thing without the HDMI audio extractor. The Chromecast is plugged directly into an HDMI port on the receiver. It works fine. Maybe whether the extractor is necessary depends on the receiver.

Whether it will work seamlessly may depend on the receiver, but I have a Chromecast plugged into an HDMI port on my Yamaha unit. (Note, there is nothing plugged into the HDMI out port on the receiver.) This setup works flawlessly for streaming audio throughout my house. Some people say they had to use an HDMI audio extractor to achieve this, but that was not necessary in my case.

Don't think so. I think it'd be the same force as it would be anchored, just distributed along more of the rope.